Ling Kenny, Fassler Richelle, Burgan Jane, Komatsu David E, Wang Edward D
Department of Orthopaedics, Stony Brook University, Stony Brook, NY.
Renaissance School of Medicine at Stony Brook University, Stony Brook, NY.
J Hand Surg Glob Online. 2023 Jul 27;5(5):661-666. doi: 10.1016/j.jhsg.2023.06.014. eCollection 2023 Sep.
Carpometacarpal (CMC) arthroplasty is an effective surgical treatment for osteoarthritis of the CMC joint. Risk factors for readmission and reoperation have been studied for other joint arthroplasty procedures but have not yet been studied for CMC arthroplasty. The purpose of this study was to identify patient demographics and comorbidities associated with 30-day readmission and 30-day reoperation after CMC arthroplasty.
The American College of Surgeons National Surgical Quality Improvement Program database was queried for all records of patients who underwent CMC arthroplasty between 2015 and 2020. Variables collected in this study included patient demographics, comorbidities, surgical characteristics, and 30-day postsurgical complication data. Multivariate logistic regression was used to identify independent associations between patient characteristics and readmission and reoperation after CMC arthroplasty.
In total, 6,432 records were included in this study: 34 (0.5%) were readmitted within 30 days, and 27 (0.4%) underwent reoperation within 30 days. Compared with the non-readmission cohort, the readmission cohort was significantly associated with higher rates of age ≥ 75 years ( = .003), body mass index (BMI) ≥ 40 kg/m ( = .005), American Society of Anesthesiologists classification (ASA) ≥ 3; < .001), insulin-dependent diabetes ( = .016), and chronic obstructive pulmonary disease (COPD; = .009). Compared with the non-reoperation cohort, the reoperation cohort was significantly associated with higher rates of age ≥ 75 years ( = .003), BMI ≥ 40 kg/m ( = .005), ASA ≥ 3 ( < .001), insulin-dependent diabetes ( = .016), and COPD ( = .009).
The clinically significant predictors for 30-day readmission and 30-reoperation after CMC arthroplasty were age ≥ 75 years, BMI ≥ 40 kg/m, ASA ≥ 3, insulin-dependent diabetes, and COPD. Of these risk factors, age and BMI were identified as independent predictors for 30-day readmission. A better understanding of presurgical risk factors for postsurgical complications may help surgeons with risk stratification and optimization of outcomes.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic III.
腕掌关节（CMC）置换术是治疗CMC关节骨关节炎的一种有效手术方法。其他关节置换手术的再入院和再次手术风险因素已得到研究，但CMC置换术的相关因素尚未得到研究。本研究的目的是确定与CMC置换术后30天再入院和30天再次手术相关的患者人口统计学特征和合并症。
查询美国外科医师学会国家外科质量改进计划数据库中2015年至2020年间接受CMC置换术患者的所有记录。本研究收集的变量包括患者人口统计学特征、合并症、手术特征和术后30天并发症数据。采用多因素逻辑回归分析确定患者特征与CMC置换术后再入院和再次手术之间的独立关联。
本研究共纳入6432条记录：34例（0.5%）在30天内再次入院，27例（0.4%）在30天内接受再次手术。与未再入院队列相比，再入院队列与以下因素显著相关：年龄≥75岁（P = 0.003）、体重指数（BMI）≥40 kg/m²（P = 0.005）、美国麻醉医师协会分级（ASA）≥3（P < 0.001）、胰岛素依赖型糖尿病（P = 0.016）和慢性阻塞性肺疾病（COPD；P = 0.009）。与未再次手术队列相比，再次手术队列与以下因素显著相关：年龄≥75岁（P = 0.003）、BMI≥40 kg/m²（P = 0.005）、ASA≥3（P < 0.001）、胰岛素依赖型糖尿病（P = 0.016）和COPD（P = 0.009）。
CMC置换术后30天再入院和30天再次手术的临床显著预测因素为年龄≥75岁、BMI≥40 kg/m²、ASA≥3、胰岛素依赖型糖尿病和COPD。在这些风险因素中，年龄和BMI被确定为30天再入院的独立预测因素。更好地了解术后并发症的术前风险因素可能有助于外科医生进行风险分层和优化治疗结果。
研究类型/证据水平：预后性研究III级
